October 2008

The Health Benefits of

Family Planning
& Reproductive
Health
FACT SHEET
KEY FACTS:

• More than 400,000 women suffer from maternal morbidities

every year.

• Women suffer more from maternal morbidities than any other

illness.

• Around 200,000 maternal morbidities—up to half the total—

can be prevented through effective family planning.

• Eleven women die each day from pregnancy and birth

complications. Most of these deaths are preventable.

• Proper birth spacing reduces by half the risk of death for

newborns and infants. More than 7,800 infant deaths can be
prevented yearly through family planning.

• Poor women and infants carry the most risk of death and
disability from lack of access to reproductive health services.

• For every peso spent in family planning, around 3 to 100

pesos will be saved in maternal care costs for unintended
pregnancies.

• At least 5.5 B (billion) pesos are spent each year in health

care costs for managing unintended pregnancies and its
complications. An annual budget of 2 to 3 B pesos for FP is a
cost-effective public health measure.

LIKHAAN
More than 400,000 women
suffer from maternal mor-
bidities every year in the
Philippines.
These are life-threatening
complications from pregnan-
cies and deliveries that often
require hospital care. The
2005 World Health Report of
the WHO (p. 62) has stated
that globally, around 80% of
all maternal deaths are the
tragic end results of the fol-
lowing complications:
• hemorrhage or severe
bleeding;
• sepsis (bloodstream
infection);
• hypertensive disorders of
pregnancy like eclamp-
sia and pre-eclampsia;
• prolonged or obstructed
labor; and
• complications of unsafe
abortion.
The remaining 20% of ma-
ternal deaths are caused by
existing illnesses that are
exacerbated by pregnancy or
its management. Examples
common in the Philippines
include anemia, tuberculo-
sis, malaria, cardiovascular
disorders and diabetes (DOH
2005a, p. 208 & 248).
Most of these morbidities
require life-saving emergency
obstetric care from primary
level hospitals. Other inter-
* 15% x 3 million pregnancies = 450,000 estimated maternal complications. This estimate is consistent with another esti-
mate shown in Table 2.
The Health Benefits of Family Planning and Reproductive Health
ventions like caesarean sec-
tion (CS) deliveries and blood
transfusion require second-
ary to tertiary level facili-
ties (UN Millennium Project
2005, pp. 83-84).
The Department of Health
and international health au-
thorities agree on the mag-
nitude and severity of this
problem. The DOH (2005a,
pp. 207-208) estimates that
there are three million preg-
nancies every year, each one
of which “entails risks to both
the mother and the unborn.”
UNICEF, WHO and UNFPA
estimate that “at least 15 per
cent of all pregnant women
develop serious complica-
Figure 1. Maternal Morbidities Compared to the Top Ten
Female Morbidities of 2005
Maternal Morbidities
ALRI and Pneumonia
Bronchitis/Bronchiolitis
Acute Watery Diarrhea
Hypertension
Influenza
TB Respiratory
Diseases of the Heart
Malaria
Chickenpox
Dengue Fever
tions that are often unpre-
dictable and require life-sav-
ing access to quality obstetric
services.” *(1997, pp. 3-4)
Women suffer more from
maternal morbidities than
any other illness.
If the estimated number of
morbidities is compared with
the Department of Health’s
list of notifiable diseases, then
maternal morbidities clearly
surpass the number of females
that are sick each year with
other serious illnesses like
pneumonias, bronchitis, diar-
rheas, hypertension, influenza,
or tuberculosis (see Figure 1).
400,000
328,956
308,930
278,958
214,220
205,419
44,440
15,324
15,003
14,748
9,434
Source: DOH 2005 b
2 Likhaan
Around 200,000 maternal morbidities—up to half the total— Eleven women die each day
can be prevented through effective family planning. from pregnancy and birth
When unintended pregnancies occur, some women resort to complications. Most of these
induced abortion while others carry their pregnancy to term. A deaths are preventable.
proportion of all these pregnancies lead to serious obstetric com- An estimated 4,100 mater-
plications. Using data from a study by the Guttmacher Institute nal deaths occurred in the
(Singh S et al. 2006) and the estimate of the UNICEF, WHO and Philippines in 2000 (WHO,
UNFPA that at least 15 per cent of all pregnant women develop UNICEF & UNFPA 2004). This
serious complications, the following table shows that half of all is equivalent to one out of
maternal morbidities are from women with unintended pregnan- every seven deaths of women
cies, and are therefore preventable through family planning. of reproductive age (National
Statistics Office - NSO 2004),
making maternal death a
Table 1. Maternal Morbidities from Intended & Unintended
grave risk for women in this
Pregnancies
age group.
Maternal Morbidities

No. % Most of these deaths are

preventable: up to half by
Intended/Planned Pregnancies
reducing unintended preg-
• carried to term (1,209,000 x 15% complication rate) 181,350 nancies through family
• hospitalized for spontaneous pregnancy loss 26,092 planning as discussed in the
previous point; and the other
Subtotal 207,442 48%
half substantially reduced
Unintended Pregnancies (Preventable Through FP) by making each pregnancy
• carried to term (961,000 x 15% complication rate) 144,150 and childbirth safer, through
• hospitalized for induced abortion 78,901
key interventions like skilled
birth attendance and access
Subtotal 223,051 52%
to emergency obstetric care.
Total 430,493 100% Many progressive countries
Sources: Singh S et al. 2006 and calculations from UNICEF, WHO, UNFPA 1997 have succeeded through
these approaches. For ex-
ample, total maternal deaths
The WHO provides a similar, global analysis in its 2005 World in all the developed regions—
Health Report, where it states that which includes Europe,
Canada, US, Japan, Australia
Unintended and unwanted pregnancies—owing to unmet need for and New Zealand—number
contraception, to contraceptive failure, or to unwanted sex—if brought only 2,500. In the Southeast
to term, carry at least the same risks as those that are desired and Asia region, Malaysia, Thai-
deliberate. It is estimated that up to 100 000 maternal deaths could be land and Vietnam—with a
avoided each year if women who did not want children used effective combined population more
contraception. When maternal illnesses are also taken into account, than twice that of the Phil-
preventing unwanted pregnancies could avert, each year, the loss of 4.5 ippines—had a total of only
million disability-adjusted life years. 2,740 maternal deaths.

The Health Benefits of Family Planning and Reproductive Health 3 Likhaan

Table 2. Maternal Mortality in Selected Countries compared to those with an
Number of Maternal Lifetime Risk
interval of three years. Data
Population
Country/Region Maternal Mortality of Maternal from the NSO’s 2003 NDHS
(2000, in M)
Deaths Ratio Death, 1 in (p. 110) support this finding:
infants born with a previous
Developed Regions 1,194 2,500 20 2,800
birth interval of less than two
Malaysia 22 220 41 660 years had a mortality rate of
Thailand 61 520 44 900
39 per thousand live births
compared to 19—a reduction
Vietnam 80 2,000 130 270 by half—for those with three
Philippines 76 4,100 200 120 years of interval.

Sources: WHO, UNICEF & UNFPA 2004; UN Population Division 2004
The lifetime risk of maternal
death combines the impact
of the frequency of preg-
nancies and the danger of
each pregnancy. Using this
measure, the risk faced by
women in the Philippines is
five to seven times that faced
by women in Malaysia and
Thailand. The Philippines is a
disproportionate contributor
of maternal deaths in South-
east Asia and the world.
Proper birth spacing reduces
by half the risk of death for
newborns and infants. More
than 7,800 infant deaths can
be prevented yearly through
family planning.
A recent review of birth
spacing studies published by
the WHO in 2006 states that
after a live birth,
the recommended interval
before attempting the next
pregnancy is at least 24 months
in order to reduce the risk of
adverse maternal, perinatal and
infant outcomes.
… To summarize, BTP [birth-
to-pregnancy] intervals of six
months or shorter are associated
with elevated risk of mater-
nal mortality. BTP intervals of
around 18 months or shorter are
associated with elevated risk of
infant, neonatal and perinatal
mortality, low birth weight, small
size for gestational age, and pre-
term delivery.
Two of the WHO-reviewed
studies show that BTP inter-
vals of less than 18 months
are linked to a two-fold
increase (1.9-2.6) in neo-
natal and infant mortality
How many infant deaths can
be prevented through birth
spacing? The 2003 NDHS
(p. 115) had estimated that
23.5% of births were of less
than 24 months interval, and
the NSO registered 1.71 mil-
lion live births in 2004 (NSO
2008). Putting all these data
together, at least 7,800 infant
deaths a year can be pre-
vented through proper birth
spacing.*
Poor women and infants
carry the most risk of death
and disability from lack
of access to reproductive
health services.
Women want fewer children
than they actually get. The
poorer they are, the larger
the gap between wanted
and actual fertility. On aver-
age, every 10 women from
the wealthiest quintile will
end up with three extra,

* 1.71 M (registered live births only; NDHS 2003 data on fertility rates combined with NSO population projections indicate
that 2.1 M live births occurred in 2000, according to Singh S et al 2006) x 23.5% (proportion of all births with <24 months
interval) x 39/1000 (mortality rate of infants with < 24 months interval) x 50% (mortality risk reduction if birth spacing of
less than 2 years is increased to 3 years)

The Health Benefits of Family Planning and Reproductive Health 4 Likhaan

unplanned births, while those from the poorest will end up with and the availability and use
21. A key factor is the inability of poor women to control their of emergency obstetric care
fertility through effective FP. Looking at the demand and use of (EmOC) as key strategies
all methods, surveys reveal a pattern of inequity—the poorer to reduce maternal deaths.
women are, the larger the unmet need for FP, and the greater the Available indicators for these
number of unplanned births. two strategies clearly show
that poorer women have less
Figure 2. Unmet Need for FP and the Wanted vs. Actual Fertility Gap access to life-saving services.
Women among the wealthi-
26.7 est quintile have already
19.6 surpassed the 2015 MDG
15.0 21 target of 90% for skilled birth
12.3 13.4 attendance while the poor-
% Unmet Need for FP 15 est have only reached 25%.
9 For EmOC, a widely available
Extra, Unplanned Births 6 statistic is the percentage of
(for every 10 women) 3 caesarean section (CS) deliv-
Wealthiest Fourth Middle Second Poorest eries, wherein it is estimated
that usage beyond 15%
Source: NSO & ORC Macro, NDHS 2003
indicates overuse while rates
below 5% signals a dangerous
The calculation of unmet The World Health Organi- lack of access (UNICEF, WHO,
need for FP was done during zation (2005) and the UN UNFPA 1997). Data from the
the period when the pub- Millennium Project (2005) 2003 NDHS show that the
lic health system was still Task Force on Maternal and poorest 40% of women have
distributing donated com- Child Health both recom- below-standard access to CS
modities for free. As a result, mend the increase in the use deliveries.
equitable access and use of of skilled birth attendance
some FP supplies, like contra-
ceptive pills, were ensured. Table 3. Use of Tubal Ligation, Skilled Birth Attendants & CS Delivery
This is a success story that by Asset Quintile
may now be rolled back after
FP donations have ended. % Caesarean Section
Delivery
Access to FP supplies may
end up like the inequitable Wealthiest 11.5 92.4 20.3
access to the costlier, for-pay Fourth 13.4 84.4 10.8
tubal ligation which results
Middle 11.2 72.4 6.8
in poorer women having
lesser rates of use. If pills Second 7.9 51.4 3.4
and other previously donated Poorest 3.9 25.1 1.7
commodities will no longer
be available as free or low
cost health supplies, then the poorest 40% poorest 60% poorest 40%
unmet need and unplanned had way below below MDG target below minimum
births of poorer women will average use (10.5%) for 2005 (80%) recommended by
UNICEF, WHO, UNFPA (5%)
rise further.
Sources: NSO & ORC Macro (NDHS 2003); UNICEF, WHO, UNFPA 1997

The Health Benefits of Family Planning and Reproductive Health 5 Likhaan

For every peso spent in fam-
ily planning, around 3 to 100
pesos will be saved in mater-
nal care costs for unintended
pregnancies.
The reimbursement rates of
PhilHealth provide a good
indicator of the average
costs of maternal care. For
normal spontaneous de-
liveries, PhilHealth (2003)
currently pays P4,500. The
costs predictably escalate for
pregnancy and delivery com-
plications. Published figures
by PhilHealth include average
benefits amounting to P4,974
for dilatation and curet-
tage for abortions (Festin M
2003); P13,413 for hyperten-
sion complicating pregnancy
and labor (Wagner A et al.
2006); and around P16,000
for caesarean section delivery
Figure 3. Family Planning versus Maternal Care Costs for Unintended Pregnancies
Family Planning Costs (per person)
IUD (good for up to 10 years)
Injectables (supply for 1 year)
Pills (supply for 1 year)
Vasectomy (at PGH)
Condoms (10 pcs/mo, for 1 year)
Tubal ligation (at PGH)
Maternal Care Costs (per person)
Normal spontaneous delivery/birth
D&C for abortion (spontaneous & induced)
Hypertensive disorders of pregnancy
Cesarean section delivery
Hysterectomy for postpartum hemorrhage
PHP
The Health Benefits of Family Planning and Reproductive Health
(Festin M 2003). PhilHealth
also published a scenario in a
2003 circular wherein it will
pay up to P19,490 plus P300
per day of confinement in a
secondary hospital for total
hysterectomy due to post-
partum haemorrhage. These
amounts do not even rep-
resent the total health care
costs since PhilHealth esti-
mates that the benefits they
provide to members comprise
only 30 to 70 percent of the
total costs per confinement
(Fajardo L 2006).
Compared to maternal care
expenses, family planning
costs are low. For example, it
costs around P200 to provide
an IUD which can last up to
ten years; less than P400
for a year’s supply of pills or
0 5,000
Sources: Aguino V 2008; Festin M 2003; Wagner A et al 2006; PhilHealth 2003
injectables; less than P600
for a year’s supply of con-
doms; P500 for vasectomy
and P1,500 for tubal ligation
in a public hospital (Aquino
V, 2008). Concretely, an IUD
worth P200 can prevent a
hysterectomy that would
amount to at least P20,000 in
public health costs plus addi-
tional out-of-pocket spending
by the patient and her family.
The DOH is aware of this
analysis and has stated in
its National Objectives for
Health (2005 a, p. 9) that
“a reduction in the actual
number of births reduces the
need for obstetrical care, im-
munization and other mater-
nal and child health interven-
tions.”
10,000 15,000 20,000
6 Likhaan
At least 5.5 B (billion) pesos are spent each year in health
care costs for managing unintended pregnancies and its
complications.
Singh et al (2006) estimates that around the year 2000, there
were 78,901 hospitalizations for induced abortions and 961,000
unintended pregnancies carried to term. The 2003 NDHS esti-
mates that 7.3% of births were done via caesarean section. Using
only these two types of maternal complications (induced abor-
tion and CS deliveries) and the benefit rates of PhilHealth (which
excludes out-of-pocket co-payments by patients), the minimum
health care costs for managing unintended pregnancies and its
complications can be estimated as follows:

Table 4. Minimum Health Care Costs for Managing Unintended Pregnancies

Number PhilHealth Total Cost
Description of Cases Benefit Rate
per Year per Case (B Pesos)

Hospitalized for abor- 78,901 4,974 0.392

tion complications

Unintended pregnancy 70,153 16,000 1.122

carried to term,
caesarean section
delivery (7.3% of
births)

Unintended pregnancy 890,847 4,500 4.009

carried to term, no
caesarean section
delivery

TOTAL 5.523

Sources: Singh et al 2006; NSO & ORC Macro 2004; PhilHealth 2003; Festin M 2003

Aquino (2008, p. 31) estimates that from 2.0 to 3.5 B pesos of

public funds are needed in 2009 to finance a range of voluntary
family planning services. Such levels of public health spending
will clearly be cost-effective, resulting in health care savings of
several billion pesos.

The Health Benefits of Family Planning and Reproductive Health 7 Likhaan

 REFERENCES

Aquino V. (2008). Completing the Family Planning Equation to Achieve Contraceptive

Self-Reliance. PLCPD

Department of Health. (2005a). National Objectives for Health, Philippines, 2005-2010.

Department of Health. (2005b). Field Health Information System Annual Report 2005.
National Epidemiology Center.

Fajardo L. (2006 February 24). PhilHealth pays P17.5B in health insurance benefits.
PhilHealth News. Retrieved 2 October 2008 from http://www.philhealth.gov.ph/
media/news/2006/022406a.htm

Festin M. (2003). Are we doing too many caesarean sections? The HTA Forum, Vol. 1 No. 2

National Statistics Office. (2004). Table 2. Number of Deaths by Age Group by Sex and
Sex Ratio, Philippines: 2000. Retrieved 26 September 2008 from http://www.
census.gov.ph/data/sectordata/2000/ds0002.htm

National Statistics Office. (2008). Live Birth Statistics: 2004. Retrieved 30 September
2008 from http://www.census.gov.ph/data/sectordata/sr08321tx.html

National Statistics Office and ORC Macro. (2004). National Demographic and Health
Survey 2003. Calverton, Maryland: NSO and ORC Macro.

PhilHealth - Philippine Health Insurance Corp. (2003). PhilHealth Circular 25 s. 2003:

Supplement to the rules on PhilHealth’s maternity care benefits for hospitals and
non-hospital facilities.

Singh S, Juarez F, Cabigon J, Ball H, Hussain R and Nadeau J. (2006). Unintended

Pregnancy and Induced Abortion in the Philippines: Causes and Consequences.
New York: Guttmacher Institute.

UNICEF, WHO, UNFPA. (1997). Guidelines for Monitoring the Availability and Use of
Obstetric Services.

UN Millennium Project. (2005). Who’s Got the Power? Transforming Health Systems for
Women and Children. Task Force on Child Health and Maternal Health.

UN Population Division. (2004). World Population to 2300. Available at http://www.

un.org/esa/population/publications/longrange2/WorldPop2300final.pdf

Wagner A, Ross-Degnan D, Valera M, Laviña S, Sia I and Galang R. (2006). An Outpatient

Prescription Drug Benefit for PhilHealth Members with Hypertension. p. 5.

WHO, UNICEF & UNFPA. (2004). Maternal mortality in 2000: Estimates developed by
WHO, UNICEF and UNFPA. Available at http://www.who.int/reproductive-health/
publications/maternal_mortality_2000/index.html

World Health Organization. (2005). The World Health Report: 2005: Make Every Mother
and Child Count. Available at http://www.who.int/whr/2005/en/index.html

World Health Organization. (2006). Report of a WHO Technical Consultation on

Birth Spacing. Available at http://who.int/reproductive-health/publications/
birthspacing/index.html

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